Basic Information
| Provider Information | |||||||||
| NPI: | 1720099476 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | FEBOS | ||||||||
| FirstName: | MARTY | ||||||||
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| Credential: | PT | ||||||||
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| Mailing Information | |||||||||
| Address1: | 120 NEWHAN AVENUE | ||||||||
| Address2: | |||||||||
| City: | BRENTWOOD | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11717 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 6318132143 | ||||||||
| FaxNumber: | 8885528178 | ||||||||
| Practice Location | |||||||||
| Address1: | 10 GORDON DRIVE | ||||||||
| Address2: | |||||||||
| City: | SYOSSET | ||||||||
| State: | NY | ||||||||
| PostalCode: | 11791 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5184964041 | ||||||||
| FaxNumber: | 8882155155 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 08/10/2006 | ||||||||
| LastUpdateDate: | 07/08/2007 | ||||||||
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| ProviderGenderCode: | M | ||||||||
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| IsSoleProprietor: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 225100000X | 014715 | NY | Y | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Physical Therapist |
No ID Information.